Form 30C AttachmentMedical Report Form / Physician's Report
Issued by Connecticut Workers' Compensation Commission
Medical Report Form / Physician's Report (Form 30C Attachment) — state-prescribed clinician report used by the state workers’ comp agency.
Key facts
Clinicians fill out · Submitted to regulator · Employers file
- When it’s used
- Initial treatment; any significant change in condition or work capacity; when employee reaches maximum medical improvement; when releasing employee to return to work (CT Gen. Stat. §31-294c).
- Who fills it out
- Treating physician of record. Connecticut allows APRNs to serve as treating providers for workers' compensation under their scope of practice (CT Gen. Stat. §20-87a). PAs may treat under supervising physician direction.
- Who signs
- Connecticut allows APRNs to serve as treating providers for workers' compensation under their scope of practice (CT Gen. Stat. §20-87a). PAs may treat under supervising physician direction.
- Where it goes
- Physician must submit reports as required by the Workers' Compensation Commission. Medical reports are typically required in connection with hearings and settlement proceedings. No fixed periodic reporting interval specified by statute.
- Electronic submission
- Supported — Connecticut WCC provides electronic filing through its online system. Medical reports and forms can be submitted through the WCC's electronic filing portal.
- Narrative substitution
- Detailed narrative medical reports are commonly accepted and may be required in addition to standard forms for hearing purposes. The Commission may prescribe the form of medical reports.
Sources & citations
Every form we publish traces to an authoritative government source. We cite the issuing agency, the underlying statute, and the operative regulation so you can verify scope and signing authority for your own records.
Issuing agency
CT Workers' Comp Commission
Statute
CT Gen. Stat. §31-275 et seq.
Form library
WCC Forms/Downloads
Attribution. Researched and maintained in collaboration with the wc-hub workers’ compensation reporting project (CT). BlueHive does not modify the underlying government PDF; the file you download is the agency original.
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